When I sit down to write these blogs, I often wonder if anyone
actually ever reads them. But finally, after 41 blogs, I have proof
positive that someone does. I wrote recently about my Grand Tour of
what was at that point 33 out of our 34 medical schools, with only
Dundee to go. I mentioned in the blog, my preference for wine in
glasses not plastic cups, and pepperoni spicy pizzas. So on Monday
night I was doing my stuff, after which there was a party with
staff and students. And guess what – yes, chilled white wine in
glasses and really excellent spicy salami pizza. So I now know that
I have at least one reader, and he/she lives in Dundee.
I don’t know if you noticed, but it seems like there is a
General Election in the offing. As you know, we don’t “do” politics
at RCPsych. Actually, that’s not true, we do a little on your
behalf. I spend so much time in Whitehall that some of the
policeman on the doors have started to call me Simon. One recently
was positively effusive, saying that he had always been one of my
greatest fans. I am not used to such a greeting, which became even
more mysterious when he added that he loved my commentaries since I
stopped playing. It finally dawned on me that he thought I was John
McInroe, a mistake that has been made before, although never when I
am playing tennis or indeed any sport.
So we do “do” politics. It’s our job. We try to influence all
the political parties on an ongoing basis to keep them on the
straight and narrow when it comes to psychiatry and mental health.
This activity however comes to a climax when an election is called,
because what we want to do is influence their manifestos. And the
window for doing this is very short – the small number of days
between the Prime Minister turning round and heading back inside
Number Ten having dropped her surprise election bombshell in April
and the manifestos being unveiled, which we are expecting next
Fortunately the folks here at RCPsych don’t believe in sleep, so
we have already put together our list. We have quickly drawn up
our wish list of absolute essentials that the
next government must commit to in order to improve the nation’s
mental health. Perhaps because of the 12550 miles I’ve on the train
to medical schools over the past three years they feature strongly
in this. Yes, 12 thousand. You read correctly.
As I have said before, and I will drone on about again countless
times without apology, delivering grand plans to improve mental
health services requires, above all else, people. Lots of them,
well trained ones, led by consultants – or in other words us,
psychiatrists. But in the last two years, numbers of psychiatrists
in the NHS have dropped 4%, with drops as big as 10% in child and
adolescent and older adult psychiatry. This picture looks set to
This is why we are making a strong call on the next government
to commit to recruiting at least 1000 more psychiatrists, a figure
which is based on those needed to deliver the Five Year Forward
View which sets out priorities and policies that the NHS and
Department of Health have committed to, more or less, for improving
and increasing access to mental health services.
So we are saying that if you are serious on the Five Year
Forward View – and all the main parties have said they are – then
this is the minimum you need for now. In fact we will need even
more than this if we are ever to treat all the people who need
support for mental illness, rather than only helping one in three
in need as we currently do.
Now you can’t just walk into your local job centre and ask if
there are any psychiatrists kicking their heels there. It’s a long
old road, usually 13 years between Fresher’s Week and emerging as a
perfectly formed consultant psychiatrist.
You may have missed it, but the Prime Minister announced at the
Conservative Party Conference in the Autumn that they are committed
to recruiting an additional 1500 medical students per year,
starting next year. I know – I was in the audience hiding at the
back. Because I failed to leap to my feet at some of the carefully
planned “applause lines” as they call it, a steward came up and
asked who I was and where was my ID? When I declared my psychiatric
allegiance, it was a little like I announced that I had Ebola, as
those on either side of me visibly moved aside.
But as soon as I heard her commitment, it immediately occurred
to me that we should lobby to ensure that this expansion was used
to increase the supply of what the NHS really needs in its medical
workforce –namely more doctors of whatever breed with more
knowledge of mental health, and second, specifically more general
practitioners and psychiatrists.
So we are calling for action to raise the knowledge of mental
health of all students, and then measures that will lead to more
choosing general practice or psychiatry.
We know that the variation in numbers of psychiatrists produced
by different medical schools is pretty huge, almost three fold.
What is going on in there? Teaching varies, some will include more
elements of psychiatry in their syllabus than others. Some barely
include mental health at all, which is a remarkable oversight in
this day and age. So we are asking for action to ensure that the
curriculae and teaching more accurately reflect the needs of the
next generation of doctors.
We are also pushing for an increase in the amount of psychiatry
that will be tested in the new National Licencing Exam coming soon
to every medical school near you.
And then there is the Foundation Year. This year we hit the
target of 45% of all medical students doing a Foundation Post in
psychiatry. Great, but why stop there? Let’s go for 100%. And so
that’s exactly what we’re calling for.
But we also need to go right back to when medical schools admit
students, by calling for psychology A-level to be treated as on a
par with traditional sciences. The very brightest of today’s school
students, who are undoubtedly far more interested in and fluent in
the language of mental health than my generation, must not be
deterred from applying to become doctors due to stuffy attitudes
that two biology, physics or chemistry A-levels are a must. Many
medical schools, amongst which is my own, do not list A-level
psychology as a science, which I have to say is nonsense.
There are some geographical areas and specialties within
psychiatry where it is pretty darn difficult to recruit and keep
doctors. Many of you work in these areas, you know what I am
talking about. To solve this, we want to flatter the GPs enormously
by pinching their successful recruitment campaign (after all, we
have already pinched their Deputy CEO to be our new Chief Exec),
and call on the Government to back a similar psychiatry recruitment
drive with financial incentives to encourage more trainees to work
in areas with recruitment difficulties.
And while we are calling for all stops to be pulled in order to
grow the future psychiatric workforce, we need to be realistic that
we can’t train people fast enough to fill the current gap unless we
can hang on to the talent that we have. The opportunities for us to
recruit doctors from outside the UK grow less and less – can I
mention Brexit now? 41% of our trainees are non-UK graduates so we
are particularly vulnerable to this. All of this means that we need
to keep our experienced doctors and enable them to work flexibly as
they approach retirement age.
Now why am I spending so much time on this? First, because it
really matters. And second, because I am quietly confident that our
work not just in the last few days, but in the months since Mrs May
first announced the expansion of medical school places, will bear
fruit. I am not making predictions – I remember well Tony Blair
once telling Jeremy Paxman that “I don’t make predictions Jeremy, I
never have and I never will”. Think about it for a second, trust
me, it’s funny.
So I don’t make predictions, but I do think we may get somewhere
Professor Sir Simon Wessely
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